G E N E R A L I N T R O D U C T I O N Early detection of obesity and prevention Early detection and prevention of obesity in an at-‐risk population is of utmost im-‐ portance. One has to identify children not only when they are already obese, but even more important are the children with the tendency of becoming obese. Multi-‐ ple strategies to prevent obesity in children are available worldwide, but most of them are applied at the moment a child is already overweight. It is more important to detect the predisposition of becoming overweight at the moment a child still has a healthy weight. For that reason knowledge of the longitudinal growth of weight and height of a healthy reference population is important. This information is avail-‐ able from the Dutch longitudinal growth study of Gerver and de Bruin45. Out of the original data of children from birth until four years of age a prediction model is constructed which gives the opportunity to calculate from each age onwards the expected height, weight and weight for height some years ahead. If the actual growth pattern of an individual child does not fit into the expected growth pattern, intervention may be needed to prevent obesity later on and thereby reduce the risk of the metabolic syndrome. Additionally, the question arises whether the study data of the reference population are conform the actual population or if there might be a change in height and weight due to a secular trend. It is of great interest to know at what age during infancy this secular trend in weight and height begins and if this trend can also be seen during intrauterine growth. As mentioned above in SGA children it is evident that the increased risk on the met-‐ abolic syndrome is already present at birth. According to international guidelines a subgroup of the SGA children is treated with human growth hormone from the age of 4 years onwards. Besides an increase in height they also show a change in their metabolism resulting in a shift towards less fat mass and more fat-‐free mass. It is assumed that this shift is important to prevent the metabolic syndrome. The ques-‐ tion arises if there is common basis for the development of the metabolic syndrome between the two groups of children, obese and SGA. Insulin resistance may play a role in the underlying pathogenesis. Outline of the thesis In the first chapter, an overview is given of the question about growth, obesity and the metabolic syndrome. In the second chapter, we investigate whether the increase in weight is related to a secular trend in height. Furthermore, it is discussed whether the increase in weight is part of the increase in height or goes beyond this. A second aim was to examine whether this secular trend in height and weight is already visible during intrauter-‐ 17
Proefschrift binnenwerk Manon Ernst_DEF.indd
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